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LEARNING OBJECTIVES
Upon completion of this chapter the student should be able to demonstrate the following competencies and proficiencies concerning the elbow and forearm:
Have basic knowledge and understanding of the elbow anatomy
Describe the normal arthrokinematics and osteokinematics of the elbow and radioulnar joints
Understand the normal biomechanics of the elbow and radioulnar joints
Recognize pathomechanics and its relation to dysfunction at the elbow and forearm
Describe and understand common elbow and forearm disorders
Have an understanding of surgical procedures used to address elbow injuries
Design a rehabilitation plan with the understanding of surgical precautions
Implement a rehabilitation plan including proper stretching, strengthening, proprioception, and exercise technique in accordance with principles of basic exercise
Perform manual treatment techniques including basic stretching, joint mobilization, and soft tissue mobilization
Demonstrate and educate the patient on a comprehensive home exercise program
Utilize adjunct treatment interventions such as pain control modalities and bracing
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The elbow and forearm provide a linkage between the hand/wrist to the upper arm and shoulder. It is one of the most stable joints in the body.1 But the elbow joint is frequently injured in the overhead athlete, when compared to the nonoverhead athlete, because of the repetitive microtrauma and high forces that are experienced particularly in pitching and tennis.1,2 Because the elbow is nonweight-bearing and experiences lower levels of force than are found in weight-bearing joints (knee, ankle), it is injured less often.3 In some sports, however, the elbow joint does function in a closed kinetic chain (i.e., gymnastics) and bears the weight of the body.3
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Rehabilitation following injury or surgery it is vital to fully restore normal elbow function and return the athlete to competition as quickly and safely as possible. Elbow rehabilitation must follow a multiphased approach to ensure that healing tissues are not compromised. Emphasis is on restoring full motion, muscular strength, and neuromuscular control and gradually applying loads to healing tissue.1,3
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Clinical Pearl 22-1
The elbow complex is a link between the wrist and shoulder and can experience abnormal forces leading to injury if there is dysfunction in either.
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The unique orientation of the elbow complex consists of three bones articulating to form four articulations. This contributes to a high degree of joint congruence and accounts for much of the difficulty experienced by the clinician obtaining normal function after injury or surgery.4,5 As a result of the many unique anatomical considerations of the elbow complex, the clinician is faced with multiple clinical challenges to successfully rehabilitate the injured elbow.
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The main functions of the joints, muscles, and connective tissues of the elbow are to precisely position the hand and to impart or resist a force (such as throwing a baseball or javelin, punching, blocking a tackle, lifting a box, or twisting a ...